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Performance Improvement on Short Volatility Strategy with Asymmetric Spillover Effect and SVM (비대칭적 전이효과와 SVM을 이용한 변동성 매도전략의 수익성 개선)

  • Kim, Sun Woong
    • Journal of Intelligence and Information Systems
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    • v.26 no.1
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    • pp.119-133
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    • 2020
  • Fama asserted that in an efficient market, we can't make a trading rule that consistently outperforms the average stock market returns. This study aims to suggest a machine learning algorithm to improve the trading performance of an intraday short volatility strategy applying asymmetric volatility spillover effect, and analyze its trading performance improvement. Generally stock market volatility has a negative relation with stock market return and the Korean stock market volatility is influenced by the US stock market volatility. This volatility spillover effect is asymmetric. The asymmetric volatility spillover effect refers to the phenomenon that the US stock market volatility up and down differently influence the next day's volatility of the Korean stock market. We collected the S&P 500 index, VIX, KOSPI 200 index, and V-KOSPI 200 from 2008 to 2018. We found the negative relation between the S&P 500 and VIX, and the KOSPI 200 and V-KOSPI 200. We also documented the strong volatility spillover effect from the VIX to the V-KOSPI 200. Interestingly, the asymmetric volatility spillover was also found. Whereas the VIX up is fully reflected in the opening volatility of the V-KOSPI 200, the VIX down influences partially in the opening volatility and its influence lasts to the Korean market close. If the stock market is efficient, there is no reason why there exists the asymmetric volatility spillover effect. It is a counter example of the efficient market hypothesis. To utilize this type of anomalous volatility spillover pattern, we analyzed the intraday volatility selling strategy. This strategy sells short the Korean volatility market in the morning after the US stock market volatility closes down and takes no position in the volatility market after the VIX closes up. It produced profit every year between 2008 and 2018 and the percent profitable is 68%. The trading performance showed the higher average annual return of 129% relative to the benchmark average annual return of 33%. The maximum draw down, MDD, is -41%, which is lower than that of benchmark -101%. The Sharpe ratio 0.32 of SVS strategy is much greater than the Sharpe ratio 0.08 of the Benchmark strategy. The Sharpe ratio simultaneously considers return and risk and is calculated as return divided by risk. Therefore, high Sharpe ratio means high performance when comparing different strategies with different risk and return structure. Real world trading gives rise to the trading costs including brokerage cost and slippage cost. When the trading cost is considered, the performance difference between 76% and -10% average annual returns becomes clear. To improve the performance of the suggested volatility trading strategy, we used the well-known SVM algorithm. Input variables include the VIX close to close return at day t-1, the VIX open to close return at day t-1, the VK open return at day t, and output is the up and down classification of the VK open to close return at day t. The training period is from 2008 to 2014 and the testing period is from 2015 to 2018. The kernel functions are linear function, radial basis function, and polynomial function. We suggested the modified-short volatility strategy that sells the VK in the morning when the SVM output is Down and takes no position when the SVM output is Up. The trading performance was remarkably improved. The 5-year testing period trading results of the m-SVS strategy showed very high profit and low risk relative to the benchmark SVS strategy. The annual return of the m-SVS strategy is 123% and it is higher than that of SVS strategy. The risk factor, MDD, was also significantly improved from -41% to -29%.

Product Evaluation Criteria Extraction through Online Review Analysis: Using LDA and k-Nearest Neighbor Approach (온라인 리뷰 분석을 통한 상품 평가 기준 추출: LDA 및 k-최근접 이웃 접근법을 활용하여)

  • Lee, Ji Hyeon;Jung, Sang Hyung;Kim, Jun Ho;Min, Eun Joo;Yeo, Un Yeong;Kim, Jong Woo
    • Journal of Intelligence and Information Systems
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    • v.26 no.1
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    • pp.97-117
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    • 2020
  • Product evaluation criteria is an indicator describing attributes or values of products, which enable users or manufacturers measure and understand the products. When companies analyze their products or compare them with competitors, appropriate criteria must be selected for objective evaluation. The criteria should show the features of products that consumers considered when they purchased, used and evaluated the products. However, current evaluation criteria do not reflect different consumers' opinion from product to product. Previous studies tried to used online reviews from e-commerce sites that reflect consumer opinions to extract the features and topics of products and use them as evaluation criteria. However, there is still a limit that they produce irrelevant criteria to products due to extracted or improper words are not refined. To overcome this limitation, this research suggests LDA-k-NN model which extracts possible criteria words from online reviews by using LDA and refines them with k-nearest neighbor. Proposed approach starts with preparation phase, which is constructed with 6 steps. At first, it collects review data from e-commerce websites. Most e-commerce websites classify their selling items by high-level, middle-level, and low-level categories. Review data for preparation phase are gathered from each middle-level category and collapsed later, which is to present single high-level category. Next, nouns, adjectives, adverbs, and verbs are extracted from reviews by getting part of speech information using morpheme analysis module. After preprocessing, words per each topic from review are shown with LDA and only nouns in topic words are chosen as potential words for criteria. Then, words are tagged based on possibility of criteria for each middle-level category. Next, every tagged word is vectorized by pre-trained word embedding model. Finally, k-nearest neighbor case-based approach is used to classify each word with tags. After setting up preparation phase, criteria extraction phase is conducted with low-level categories. This phase starts with crawling reviews in the corresponding low-level category. Same preprocessing as preparation phase is conducted using morpheme analysis module and LDA. Possible criteria words are extracted by getting nouns from the data and vectorized by pre-trained word embedding model. Finally, evaluation criteria are extracted by refining possible criteria words using k-nearest neighbor approach and reference proportion of each word in the words set. To evaluate the performance of the proposed model, an experiment was conducted with review on '11st', one of the biggest e-commerce companies in Korea. Review data were from 'Electronics/Digital' section, one of high-level categories in 11st. For performance evaluation of suggested model, three other models were used for comparing with the suggested model; actual criteria of 11st, a model that extracts nouns by morpheme analysis module and refines them according to word frequency, and a model that extracts nouns from LDA topics and refines them by word frequency. The performance evaluation was set to predict evaluation criteria of 10 low-level categories with the suggested model and 3 models above. Criteria words extracted from each model were combined into a single words set and it was used for survey questionnaires. In the survey, respondents chose every item they consider as appropriate criteria for each category. Each model got its score when chosen words were extracted from that model. The suggested model had higher scores than other models in 8 out of 10 low-level categories. By conducting paired t-tests on scores of each model, we confirmed that the suggested model shows better performance in 26 tests out of 30. In addition, the suggested model was the best model in terms of accuracy. This research proposes evaluation criteria extracting method that combines topic extraction using LDA and refinement with k-nearest neighbor approach. This method overcomes the limits of previous dictionary-based models and frequency-based refinement models. This study can contribute to improve review analysis for deriving business insights in e-commerce market.

The Influence of Ventilation and Shade on the Mean Radiant Temperature of Summer Outdoor (통풍과 차양이 하절기 옥외공간의 평균복사온도에 미치는 영향)

  • Lee, Chun-Seok;Ryu, Nam-Hyung
    • Journal of the Korean Institute of Landscape Architecture
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    • v.40 no.5
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    • pp.100-108
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    • 2012
  • The purpose of the study was to evaluate the influence of shading and ventilation on Mean Radiant Temperature(MRT) of the outdoor space at a summer outdoor. The Wind Speed(WS), Air Temperature(AT) and Globe Temperature(GT) were recorded every minute from $1^{st}$ of May to the $30^{th}$ of September 2011 at a height of 1.2m above in four experimental plots with different shading and ventilating conditions, with a measuring system consisting of a vane type anemometer(Barini Design's BDTH), Resistance Temperature Detector(RTD, Pt-100), standard black globe(${\O}$ 150mm) and data acquisition systems(National Instrument's Labview and Compfile Techs' Moacon). To implement four different ventilating and shading conditions, three hexahedral steel frames, and one natural plot were established in the open grass field. Two of the steel frames had a dimension of $3m(W){\times}3m(L){\times}1.5m(H)$ and every vertical side covered with transparent polyethylene film to prevent lateral ventilation(Ventilation Blocking Plot: VP), and an additional shading curtain was applied on the top side of a frame(Shading and Ventilation Blocking Plot: SVP). The third was $1.5m(W){\times}1.5m(L){\times}1.5m(H)$, only the top side of which was covered by the shading curtain without the lateral film(Shading Plot: SP). The last plot was natural condition without any kind of shading and wind blocking material(Natural Open Plot: NP). Based on the 13,262 records of 44 sunny days, the time serial difference of AT and GT for 24 hour were analyzed and compared, and statistical analysis was done based on the 7,172 records of daytime period from 7 A.M. to 8 P.M., while the relation between the MRT and solar radiation and wind speed was analyzed based on the records of the hottest period from 11 A.M. to 4 P.M.. The major findings were as follows: 1. The peak AT was $40.8^{\circ}C$ at VP and $35.6^{\circ}C$ at SP showing the difference about $5^{\circ}C$, but the difference of average AT was very small within${\pm}1^{\circ}C$. 2. The difference of the peak GT was $12^{\circ}C$ showing $52.5^{\circ}C$ at VP and $40.6^{\circ}C$ at SP, while the gap of average GT between the two plots was $6^{\circ}C$. Comparing all four plots including NP and SVP, it can be said that the shading decrease $6^{\circ}C$ GT while the wind blocking increase $3^{\circ}C$ GT. 3. According to the calculated MRT, the shading has a cooling effect in reducing a maximum of $13^{\circ}C$ and average $9^{\circ}C$ MRT, while the wind blocking has heating effect of increasing average $3^{\circ}C$ MRT. In other words, the MRT of the shaded area with natural ventilation could be cooler than the wind blocking the sunny site to about $16^{\circ}C$ MRT maximum. 4. The regression and correlation tests showed that the shading is more important than the ventilation in reducing the MRT, while both of them do an important role in improving the outdoor thermal comfort. In summary, the results of this study showed that the shade is the first and the ventilation is the second important factor in terms of improving outdoor thermal comfort in summer daylight hours. Therefore, it can be apparently said that the more shade by the forest, shading trees etc., the more effective in conditioning the microclimate of an outdoor space reducing the useless or even harmful heat energy for human activities. Furthermore, the delicately designed wind corridor or outdoor ventilation system can improve even the thermal environment of urban area.

Comparison and evaluation of volumetric modulated arc therapy and intensity modulated radiation therapy plans for postoperative radiation therapy of prostate cancer patient using a rectal balloon (직장풍선을 삽입한 전립선암 환자의 수술 후 방사선 치료 시 용적변조와 세기변조방사선치료계획 비교 평가)

  • Jung, hae youn;Seok, jin yong;Hong, joo wan;Chang, nam jun;Choi, byeong don;Park, jin hong
    • The Journal of Korean Society for Radiation Therapy
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    • v.27 no.1
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    • pp.45-52
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    • 2015
  • Purpose : The dose distribution of organ at risk (OAR) and normal tissue is affected by treatment technique in postoperative radiation therapy for prostate cancer. The aim of this study was to compare dose distribution characteristic and to evaluate treatment efficiency by devising VMAT plans according to applying differed number of arc and IMRT plan for postoperative patient of prostate cancer radiation therapy using a rectal balloon. Materials and Methods : Ten patients who received postoperative prostate radiation therapy in our hospital were compared. CT images of patients who inserted rectal balloon were acquired with 3 mm thickness and 10 MV energy of HD120MLC equipped Truebeam STx (Varian, Palo Alto, USA) was applied by using Eclipse (Version 11.0, Varian, Palo Alto, USA). 1 Arc, 2 Arc VMAT plans and 7-field IMRT plan were devised for each patient and same values were applied for dose volume constraint and plan normalization. To evaluate these plans, PTV coverage, conformity index (CI) and homogeneity index (HI) were compared and $R_{50%}$ was calculated to assess low dose spillage as per treatment plan. $D_{25%}$ of rectum and bladder Dmean were compared on OAR. And to evaluate the treatment efficiency, total monitor units(MU) and delivery time were considered. Each assessed result was analyzed by average value of 10 patients. Additionally, portal dosimetry was carried out for accuracy verification of beam delivery. Results : There was no significant difference on PTV coverage and HI among 3 plans. Especially CI and $R_{50%}$ on 7F-IMRT were the highest as 1.230, 3.991 respectively(p=0.00). Rectum $D_{25%}$ was similar between 1A-VMAT and 2A-VMAT. But approximately 7% higher value was observed on 7F-IMRT compare to the others(p=0.02) and bladder Dmean were similar among the all plan(P>0.05). Total MU were 494.7, 479.7, 757.9 respectively(P=0.00) for 1A-VMAT, 2A-VMAT, 7F-IMRT and at the most on 7F-IMRT. The delivery time were 65.2sec, 133.1sec, 145.5sec respectively(p=0.00). The obvious shortest time was observed on 1A-VMAT. All plans indicated over 99.5%(p=0.00) of gamma pass rate (2 mm, 2%) in portal dosimetry quality assurance. Conclusion : As a result of study, postoperative prostate cancer radiation therapy for patient using a rectal balloon, there was no significant difference of PTV coverage but 1A-VMAT and 2A-VMAT were more efficient for dose reduction of normal tissue and OARs. Between VMAT plans. $R_{50%}$ and MU were little lower in 2A-VMAT but 1A-VMAT has the shortest delivery time. So it is regarded to be an effective plan and it can reduce intra-fractional motion of patient also.

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A study of the difference of Dongeui-Suse-Bowon and past Oriental-Medicine appeared in the argument of Interior-overheating-sympton of the Tae-Eum-In caused by liver's receiving heat (태음인(太陰人) 간수열(肝受熱) 이열병론(裡熱病論)을 통해 살펴본 과거의학(過去醫學)과 동의수세보원(東醫壽世保元)의 음양관(陰陽觀)의 차이(差異))

  • Kim, Jong-Weon
    • Journal of Sasang Constitutional Medicine
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    • v.9 no.1
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    • pp.127-153
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    • 1997
  • Sasang-Medicine can classify all sympton with more simple classifying system than past Oriental-Medicine, because Sasang Byeon-Zeung(=classifying system of the sympton) separate by four clearly. The merit of this Sasang Byeon-Zeung can be seen more clearly on the part of the pathology of the expiratory-scattering and inspiratory-gathering of the Tae-Eum and Tae-Yang. On this view point, this thesis discussed the following subjects. 1. Investigate the theory of raising-falling and scattering-gathering developed in the Dongeui-Suse-Bowon. 2. Investigate the changes of the recognition of the Yang-Dog sympton and Jo-Yeol sympton argued as Interior-overheating-sympton of the Tae-Eum-In caused by liver's receiving heat. 3. Investigate the Yi-Je-Ma's view on the Eum-Yang in the argument of interior-overheating-sympton of the Tae-Eum-In caused by liver's receiving heat. As a result, the following conclusions were led to. 1. Dongeui-Suse-Bowon considers Spleen-Kidney has the couple motion of the raising Yang and falling Eum, and Liver-Lung has the couple motion of the expiratory-scattering and inspiratory-gathering. This theory of raising-falling and scattering-gathering is same as in the concept with the gathering. This theory of raising-falling and scattering-gathering is same as in the concept with the theory of raising-falling and floating-sinking of past Oriental-Medicine, but more consistently systematized in the pathology and prescription. 2. Dongeui-Suse-Bowon considers the Yang-Dog sympton and Jo-Yeol sympton as the interior-overheating-sympton of the Tae-Eum-In. As following the book, the fire of desire weeken the expiratory-scattering power of the lung, and deepen the shortage of the expiratory-scattering power comparison to the inspiratory-gathering power. Therfore the sympton can be treated by releasing ourselves from the desire and taking medicine strengthening the expiratory-scattering power. 3. In the early stage of the orintal medicine, they used prescriptions composed of So-Yang medicine and Tae-Eum medicine which can cool heat. Galgeun, Mawhang and Seungma were used in the age of Sanghanron, thereafter Jugoing's Jojung-Tang and Gongsin's Galgeunhaegi-Tang were developed as prescriptions of the interior-overheating-sympton of the Tae-Eum-In, and finally Tea-Uem-In Galgeunhaegi-Tang was settled by Yi-Je-Ma.

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Survey of Weed Population Distribution and Change of Dominant Weed Species on Paddy Field in Kyonggi Area (경기지역(京畿地域)의 논 잡초(雜草) 분포(分布) 및 군락변화(群落變化)에 관(關)한 연구(硏究))

  • Kim, H.D.;Park, J.S.;Su, K.K.;Moon, M.H.;Jo, Y.C.;Park, K.Y.;Choi, Y.J.;Yu, C.J.;Shim, S.W.;Rho, Y.D.
    • Korean Journal of Weed Science
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    • v.17 no.1
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    • pp.1-9
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    • 1997
  • The survey of weed community in paddy field was carried out to investigate the changes of weed species on 340 fields in Kyonggi Area in 1995, that is almost same condition as sampled in 1991. The weed species observed include 3 species of grasses, 5 species of sedges and 14 species of broadleaf and other weed. Herbicide treatment system in one time treatment vs more than two time treatment was 34:66 percentage. About 25 percentage among one time treatment system was used butachlor G. Ratio of annual weed vs perennial weed was 38:62, and then perennial weed ratio was high. Major dominant weed species were Sagitaria trifolia, Eleocharis kuroguwai, Echinochloa crus-galli, Bidens tripartita and Monochoria vaginalis. Weed occurrence was decreased as order of normal soil, poorly drained soil and saline soil. Dormant weed species were S. trifolia, E. kuroguwai, E. crus-galli and B. tripartita in normal soil and were S. trifolia, E. kuroguwai, E. crus-galli and Polygonium hydropiper in poorly drained soil, and were Scirpus planiculmis, S. trifolia and E. kuroguwai in saline soil. Weed occurrence was increased with delaying the transplanting time; dominant weed species were S. trifolia, E. kuroguwai, E. crus-galli and M. vaginalis in May transplanting field and were E. kuroguwai, S. trifolia, and C. serotinus in June transplanting field. Weed occurrence was decreased as order of non-plowing transplanting field, autumn plowing and spring plowing paddy field. Dominant weed species were S. trifolia, E. kuroguwai, E. crus-galli and M. vaginalis in autumn plowing, were S. trifolia, E. kuroguwai, E. crus-galli and B. tripartita in spring plowing, and were E. crus-galli, S. hotarui and S. trifolia in non-plowing transplanting field.

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Development of Korean Version of Heparin-Coated Shunt (헤파린 표면처리된 국산화 혈관우회도관의 개발)

  • Sun, Kyung;Park, Ki-Dong;Baik, Kwang-Je;Lee, Hye-Won;Choi, Jong-Won;Kim, Seung-Chol;Kim, Taik-Jin;Lee, Seung-Yeol;Kim, Kwang-Taek;Kim, Hyoung-Mook;Lee, In-Sung
    • Journal of Chest Surgery
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    • v.32 no.2
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    • pp.97-107
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    • 1999
  • Background: This study was designed to develop a Korean version of the heparin-coated vascular bypass shunt by using a physical dispersing technique. The safety and effectiveness of the thrombo-resistant shunt were tested in experimental animals. Material and Method: A bypass shunt model was constructed on the descending thoracic aorta of 21 adult mongrel dogs(17.5-25 kg). The animals were divided into groups of no-treatment(CONTROL group; n=3), no-treatment with systemic heparinization(HEPARIN group; n=6), Gott heparin shunt (GOTT group; n=6), or Korean heparin shunt(KIST group; n=6). Parameters observed were complete blood cell counts, coagulation profiles, kidney and liver function(BUN/Cr and AST/ ALT), and surface scanning electron microscope(SSEM) findings. Blood was sampled from the aortic blood distal to the shunt and was compared before the bypass and at 2 hours after the bypass. Result: There were no differences between the groups before the bypass. At bypass 2 hours, platelet level increased in the HEPARIN and GOTT groups(p<0.05), but there were no differences between the groups. Changes in other blood cell counts were insignificant between the groups. Activated clotting time, activated partial thromboplastin time, and thrombin time were prolonged in the HEPARIN group(p<0.05) and differences between the groups were significant(p<0.005). Prothrombin time increased in the GOTT group(p<0.05) without having any differences between the groups. Changes in fibrinogen level were insignificant between the groups. Antithrombin III levels were increased in the HEPARIN and KIST groups(p<0.05), and the inter-group differences were also significant(p<0.05). Protein C level decreased in the HEPARIN group(p<0.05) without having any differences between the groups. BUN levels increased in all groups, especially in the HEPARIN and KIST groups(p<0.05), but there were no differences between the groups. Changes of Cr, AST, and ALT levels were insignificant between the groups. SSEM findings revealed severe aggregation of platelets and other cellular elements in the CONTROL group, and the HEPARIN group showed more adherence of the cellular elements than the GOTT or KIST group. Conclusion: Above results show that the heparin-coated bypass shunts(either GOTT or KIST) can suppress thrombus formation on the surface without inducing bleeding tendencies, while systemic heparinization(HEPARIN) may not be able to block activation of the coagulation system on the surface in contact with foreign materials but increases the bleeding tendencies. We also conclude that the thrombo-resistant effects of the Korean version of heparin shunt(KIST) are similar to those of the commercialized heparin shunt(GOTT).

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The Effect of the Simple Fogarty Thromboembolectomy (단순 Fogarty 혈전색전 제거술의 효과)

  • Oh, Joong-Hwan;Park, Il-Hwan;Lee, Chong-Kookk
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.480-486
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    • 2009
  • Background: The Fogarty thromboembolectomy catheter technique was devised to extract distal arterial emboli and it represents a milestone for the treatment of patients with acute arterial occlusion since the 1960s. The major causes of arterial occlusion have changed from emboli of a heart origin to atherosclerosis over the past 30 years. Accordingly, questions have been raised about the effectiveness of simple Fogarty thromboembolectomy. Material and Method: During the period from March 1990 through August 2008, 156 patients who requiring Fogarty thromboembolectomy were analyzed. The patients were divided into two groups: those with simple Fogarty thromboembolectomy (Group 1, 79 patients) and those with additional vascular bypass graft surgery (Group 2, 77 patients). The duration of symptoms, the cause of thrombi, admission via the emergency room, a history of acupuncture or misdiagnosis, combined diseases, the anatomic occlusion site and the cause of death were analyzed using T-tests, cross tab tests, Chi square tests and Kaplan-Meier tests, respectively. Result: The mean age was 64$\pm$10 years in the 2 groups. The duration of symptoms (pain) in Group 1 vs Group 2 was 12$\pm$4 days vs 71$\pm$14 days (p=0.001). 50 (63%) patients in Group 1 were admitted via the emergency room vs 18 (23%) patients in Group 2 (p=0.005). Misdiagnosis and the treatment for herniated intervertebral disc or acupuncture were given to, 20 (25%) patients in Group 1 vs 30 (39%) patients in Group 2. Anticoagulation treatment before admission was performed in 22 (28%) patients in Group 1 vs 11 (14%) patients in Group 2. The causes of thrombi were heart disease in, 24 (30%) patients in Group 1 vs 6 (8%) patients in Group 2 (p=0.001), atherosclerosis in 46 (58%) patients in Group 1 vs 67 (87%) patients in Group 2 (p=0.001) and trauma in 9 (11%) patients in Group 1 vs 6 (8%) patients in Group 2. The combined diseases were cerebrovascular accident, hypertension and diabetes mellitus in 22 $\sim$ 37% of the total patients. The occlusion sites were mainly in the iliac and femoral arteries. Endarterectomy was performed in 7 (9%) patients in Group 1 vs 18 (23%) patients in Group 2 (p=0.012). Treatment was successful in 27 (34%) patients in Group 1 and in 40 (52%) patients in Group 2 (p=0.019). Reocclusion occurred in 37(47%) patients in Group 1 vs 20 (26%) patients in Group 2 (p=0.000), Amputation was done in 4 (5%) patients in Group 1 vs 12 (16%) patients in Group 2 (p=0.012) and death occurred in 10 (13%) patients (Group 1) vs 3(4%) patients (Group 2) (p=0.044). Conclusion: The recent past has shown a decline in the effectiveness of simple Fogarty thromboembolectomy with a changing pattern of acute arterial occlusion from a rheumatic heart origin to atherosclerosis. Additional bypass procedures play a role for the treatment of arterial occlusion instead of always performing simple Fogarty thromboembolectomy.

Retrograde Autologous Priming: Is It Really Effective in Reducing Red Blood Cell Transfusions during Extracorporeal Circulation? (역행성 자가혈액 충전법: 체외순환 중 동종적혈구 수혈량을 줄일 수 있는가?)

  • Lim, Cheong;Son, Kuk-Hui;Park, Kay-Hyun;Jheon, Sang-Hoon;Sung, Sook-Whan
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.473-479
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    • 2009
  • Background: Retrograde autologous priming (RAP) is known to be useful in decreasing the need of transfusions in cardiac surgery because it prevents excessive hemodilution due to the crystalloid priming of cardiopulmonary bypass circuit. However, there are also negative side effects in terms of blood conservation. We analyzed the intraoperative blood-conserving effect of RAP and also investigated the efficacy of autotransfusion and ultrafiltration as a supplemental method for RAP. Material and Method: From January 2005 to December 2007, 117 patients who underwent isolated coronary artery bypass operations using cardiopulmonary bypass (CPB) were enrolled. Mean age was 63.9$\pm$9.1 years (range 36$\sim$83 years) and 34 patients were female. There were 62 patients in the RAP group and 55 patients in he control group. Intraoperative autotransfusion was performed via the arterial line. RAP was done just before initiating CPB using retrograde drainage of the crystalloid priming solution. Both conventional (CUF) and modified (MUF) ultrafiltrations were done during and after CPB, respectively. The transfusion threshold was less than 20% in hematocrit. Result: Autotransfusions were done in 79 patients (67.5%) and the average amount was 142.5$\pm$65.4 mL (range 30$\sim$320 mL). Homologous red blood cell (RBC) transfusion was done in 47 patients (40.2%) and mean amount of transfused RBC was 404.3$\pm$222.6 mL. Risk factors for transfusions were body surface area (OR 0.01, 95% CI 0.00 $\sim$ 0.63, p=0.030) and cardiopulmonary bypass time (OR 1.04, 95% CI 1.01 $\sim$ 1.08, p=0.019). RAP was not effective in terms of the rate of transfusion (34.5% vs 45.2%, p=0.24). However, the amount of transfused RBC was significantly decreased (526.3$\pm$242.3ml vs 321.4$\pm$166.3 mL, p=0.001). Autotransfusion and ultrafiltration revealed additive and cumulative effects decreasing transfusion amount (one; 600.0$\pm$231.0 mL, two; 533.3$\pm$264.6 mL, three; 346.7$\pm$176.7 mL, four; 300.0$\pm$146.1 mL, p=0.002). Conclusion: Even though RAP did not appear to be effective in terms of the number of patients receiving intraoperative RBC transfusions, it could conserve blood in terms of the amount transfused and with the additive effects of autotransfusion and ultrafiltration. If we want to maximize the blood conserving effect of RAP, more aggressive control will be necessary - such as high threshold of transfusion trigger or strict regulation of crystalloid infusion, and so forth.

Clinical Experiences for Cardiac Myxomas (심장 점액종의 임상적 고찰)

  • Lee, Geun-Dong;Lee, Jae-Won;Jung, Jae-Seung;Jung, Sung-Ho;Je, Hyoung-Gon;Choo, Suk-Jung;Song, Hyun;Chung, Cheol-Hyun
    • Journal of Chest Surgery
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    • v.41 no.6
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    • pp.703-709
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    • 2008
  • Background: Diagnosis and treatment are often successful in the setting of cardiac myxomas. However, cardiac myxomas can lead to catastrophic complications, due to intracardiac obstruction and embolism preoperatively, and can recur postoperatively. Material and Method: We retrospectively reviewed the clinical characteristics, surgical treatment, and recurrence data of 85 patients who underwent cardiac myxoma surgery at Asan Medical Center between November 1994 and June 2007. We analyzed the morphologic characteristics of 58 patients with left atrial myxomas and determined the development of functional mitral valve stenosis and systemic embolism through reviewing the results of preoperative echo-cardiograms to find potential preoperative risk factors. Result: Twenty-seven (31.8%) patients were men, and 58 (68.2%) were women. The mean patient age was $54.5{\pm}14.3$ years. Preoperative symptoms included obstructive symptoms in 41 (48.2%) patients, signs of embolism in 19 (22.4%), constitutional symptoms in 8 (9.4%), and no symptoms in 19 (20.0%). Among the 58 patients with left atrial myxomas, the mean maximal tumor diameter was $4.3{\pm}1.8$ (range $1.1{\sim}8\;cm$)cm. Twenty-six (44.8%) patients had a prolapsing type, defined as a tumor mobile enough to move down. to the mitral. annular plane during diastole, and 32 (55.2%) had villous type, defined as a tumor consisting of multiple fine villous extensions on the surface. Twelve (20.7%) patients had severe functional mitral valve stenosis, and 15 (25.9%) had systemic embolism preoperatively. The incidence of severe functional mitral valve stenosis was significantly higher in patients with the prolapsing type than in those with the non-prolapsing type (p=0.001). The mean maximal tumor diameter in patients with severe functional mitral valve stenosis was $5.1{\pm}1.0\;cm$, significantly larger than that seen in patients without severe functional mitral valve stenosis (p=0.041). The incidence of systemic embolism was significantly higher in patients with the villous type than in those with the smooth type (p=0.006). Postoperative complications were noted in 6 (7.1%) patients, and early mortality was noted in 1 (1.2%). The mean postoperative follow-up duration was $36.2{\pm}37.5$ months, with recurrence reported in 2(2.4%) patients during the follow-up period. The disease free interval were 48, 12 months, respectively. Conclusion: Surgical treatment for cardiac myxomas was performed safely, and long-term prognosis was good. In patients with left atrial myxoma, close attention should be maintained and surgery should be performed promptly in those of prolapsing type, those with large maximal diameter in order to prevent severe functional mitral valve stenosis, and those of villous type in order to prevent systemic embolism. Echocardiography should be followed serially in order to detect recurrence.